Journal
MUSCLE & NERVE
Volume 42, Issue 2, Pages 157-164Publisher
WILEY
DOI: 10.1002/mus.21661
Keywords
diabetes mellitus; diabetic sensorimotor polyneuropathy; nerve conduction score
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Funding
- Kawamura Fund
- Neurologic Education and Research of Rochester, MN
- National Institute of Neurological Disorders and Stroke [NS36797]
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The purpose was to test whether physicians can validly and reproducibly diagnose diabetic sensorimotor polyneuropathy (DSPN). Twelve physicians assessed 24 patients with diabetes mellitus (DM) on consecutive days (576 examinations) with physical features and voice disguised. Results were compared to gold standard 75% group diagnosis (dx) and a nerve conduction score (Sigma 5 NC nds). Masking of patients was achieved. Reproducibility measured by the kappa coefficient and compared to Sigma 5 NC nd varied considerably among physicians: median and ranges: signs 0.8 (0.32-1.0); symptoms 0.79 (0.36-1.0), and diagnoses 0.47 (0.33-0.84), both low and high scores indicating poor performance. There was substantial agreement between 75% group dx and confirmed NC abnormality (abn). As compared to Sigma 5 NC, individual physicians' clinical dx was excessively variable and frequently inaccurate. Study physician dx from signs and symptoms were excessively variable, often overestimating DSPN. Specific approaches to improving clinical proficiency should be tested. Muscle Nerve 42: 157-164,2010
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